Hospitals which are not following waiting list rules for public patients are breaching policy in the same manner as gardaí fixing penalty points, Health Minister Leo Varadkar has warned.

He was commenting after revelations in the Irish Independent on unpublished audits that found that a majority of hospitals are not treating all those who are longest on public waiting lists first.

Mr Varadkar said: "The policy on waiting times is crystal clear. Urgent patients should be seen first and everyone else then in chronological order.

"It is disturbing if hospitals are not following the policy and are therefore contributing to the problem of long waiting times. I consider queue-skipping to be as serious a breach of policy as fixing penalty points for the Gardaí or breaching a school admissions policy."

Public patients on waiting lists for surgery or an outpatient appointment have been promised they will not be waiting longer than 18 months at the end of June, according to revised deadlines.

But audits which were carried out by the National Treatment Purchase Fund showed many hospitals are not managing outpatient clinics properly despite recent figures showing more than 400,000 are waiting to see a specialist.

Responding to the criticism, Prof Michael O'Keeffe, an ophthalmologist in the Mater Hospital in Dublin, said it may be necessary to bring forward some patients who have been waiting less time than others.

"For instance in the area of cataract surgery you can have patients who are very old and very visually impaired. You can have younger patients who may not be as bad, but cannot work because of their lack of vision. They need to get back to work to make a living."

"In my practice, I would expedite both of them. You have to make a call based on merit.

"If you are working at the coalface that is the decision you have to make. Most doctors around me in this hospital make the same judgments."

Fee

He said there may possibly be other hospitals where patients are pushed forward because they are on a public waiting lists, but have health insurance and a fee will be paid.

But he added: "I don't know if that is happening or not. I have no evidence that it is."

He pointed out that hospitals are "desperate for money" and suggested patients could potentially be earmarked if they have private health insurance.